KinderCare Settlement Agreement

re: Diabetes Finger-Prick Tests

The Department of Justice, DREDF, and the American Diabetes Association recently reached a settlement agreement under which KinderCare will accept children with diabetes into its child care program, do simple "finger prick" blood glucose monitoring, and provide appropriate care in response to low blood sugar levels. KinderCare will also undergo a three-year employee training program on a wide range of disability related issues.

SETTLEMENT AGREEMENT UNDER THE
AMERICANS WITH DISABILITIES ACT

THIS SETTLEMENT AGREEMENT ("Agreement") is made by and among KinderCare Learning Centers, Inc. ("KinderCare"), Jesi Stuthard, by his next friend Patricia Dollison, the American Diabetes Association, the American Diabetes Association, Ohio Affiliate, Inc. (collectively "Plaintiffs"), and the United States of America ("United States").

WHEREAS, on February 26, 1996, Jesi Stuthard by his next friend Patricia Dollison; the American Diabetes Association; and the American Diabetes Association, Ohio Affiliate, Inc., filed an action entitled Jesi Stuthard, a minor child, by Patricia Dollison, his next friend, et al. v. KinderCare Learning Centers, Inc., as Case No. C2-96-0185, in the United States District Court for the Southern District of Ohio, Eastern Division (the "Stuthard Case") alleging, among other claims, that KinderCare had violated Title III of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. ßß 12181-89, and Section 4112.02(G) of the Ohio Revised Code, by refusing to monitor the blood glucose levels of Jesi Stuthard and other children with insulin-dependent diabetes; and

WHEREAS, KinderCare maintained a policy which allowed children or their parent(s), guardian(s), or authorized agent(s) to monitor the child's blood glucose levels; and

WHEREAS, the United States, which is not a party to the Stuthard Case, simultaneously conducted an investigation prompted by two complaints (DJ 202-58-18 and DJ 202-26S-3) which alleged that KinderCare's policies regarding the monitoring and treatment of children with diabetes violated Section 302 of the ADA, 42 U.S.C. ß 12182, and the Department of Justice's implementing regulation, 28 C.F.R. ßß 36.201(a), 36.202, 36.301(a), and 36.302, and violated the rights of their parent(s) and/or guardian(s) under Section 302(b)(1)(E), 42 U.S.C. ß 12182(b)(1)(E), and the Title III regulation, 28 C.F.R. ß 36.205; and

WHEREAS, the United States and KinderCare agree that resolution of this investigation is in the public interest and that the matters raised therein can be resolved as set forth below; and

WHEREAS, KinderCare has and continues to deny any and all liability with respect to the allegations made in the Complaint by the Plaintiffs or the investigation conducted by the United States and nothing in this Agreement, including the payment of any sums by KinderCare, constitutes an admission by KinderCare of any such wrongdoing, or liability, or otherwise constitutes a violation of the ADA and/or the Ohio Revised Code; and

WHEREAS, KinderCare and the Plaintiffs desire to resolve the Stuthard Case and all matters relating to the subject matter thereof.

NOW, THEREFORE, for and in consideration of the mutual promises and the releases as set forth herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, KinderCare, the Plaintiffs and the United States agree as follows.

1. KinderCare has cooperated fully in the United States' investigation and has demonstrated a commitment to provide its services to persons with disabilities without discrimination. The parties have agreed that this matter can be resolved without resort to further litigation.

2. KinderCare is a public accommodation within the meaning of Title III of the ADA, 42 U.S.C. ß 12181(7), and its implementing regulation, 28 C.F.R. ß 36.104, as it owns and operates approximately 1,200 child care centers nationwide.

3. KinderCare will not refuse to admit any child to any of its programs on the basis that the child has insulin-dependent diabetes or needs blood glucose testing. Prior to a child's enrollment into its program, KinderCare will not inquire specifically whether a child has diabetes or needs diabetes-related care or monitoring.

4. When informed that a child has insulin-dependent diabetes, KinderCare will advise the child's parent(s) or guardian(s) of the KinderCare Policy on Testing Blood Glucose Levels, a copy of which is attached hereto as Exhibit 1 (the "Policy on Testing Blood Glucose Levels") and, when asked to do so, KinderCare will monitor the child's blood glucose levels, including administration of the finger-prick test, in accordance with the Policy on Testing Blood Glucose Levels.

5. In connection with the monitoring of a child's blood glucose levels, KinderCare will take only those actions instructed on the child's Authorization for Care of Children with Insulin-Dependent Diabetes form (the "Authorization Form") executed by the child's physician and parent(s) or guardian(s), which is attached hereto as Exhibit 2 and which shall be provided in substantially the same format as set forth in Exhibit 2. Some of the actions provided for in the Authorization Form include, but are not limited to, the following:

(a) Administering certain fast-acting carbohydrates, as supplied by the parent(s) or guardian(s);
(b) Administering certain complex carbohydrates as supplied by the parent(s) or guardian(s);
(c) Calling "911" or other emergency medical personnel, parent(s) or guardian(s), and the child's doctor in the event of loss of consciousness or seizure or other medical emergency;
(d) Providing notification to the parent(s) or guardian(s) of high blood glucose levels;
(e) Telephoning the parent(s) or guardian(s) and the child's physician in the event of very high blood glucose levels;
(f) Monitoring the child's diet as instructed by the child's physician; and
(g) Monitoring the child's recreational activities as instructed by the child's physician.

6. KinderCare will keep records of any test it performs in accordance with its Policy on Testing Blood Glucose Levels for a period of six (6) months from the date of the test. KinderCare will provide copies of these records to the child's parent(s) or guardian(s), upon written request on a form provided by KinderCare when such a request is made, the reasonable copying costs being borne by the parent(s) or guardian(s).

7. Nothing in this Agreement requires KinderCare to administer insulin shots to anyone.

8. Notwithstanding Paragraphs 4 and 5, KinderCare will allow the parent(s) or guardian(s), or authorized agent(s), to enter KinderCare's premises at any time a child is in KinderCare's care, to monitor the child's blood glucose levels and take appropriate action in response to those levels. KinderCare also will allow the child to monitor her or his own blood glucose levels and take appropriate action in response to those levels when the child's parent(s) or guardian(s) have provided KinderCare with written authorization to do so.

9. KinderCare may request the child's parent(s) or guardian(s) to provide KinderCare with, but not limited to, the following:

(a) All equipment, food, and substances, not regularly provided by KinderCare, that are necessary for taking any actions described in the child's Authorization Form or KinderCare's Policy on Testing Blood Glucose Levels;
(b) Permission to undertake the steps indicated on the Authorization Form and to respond to any diabetes-related emergency in a manner consistent with those instructions;
(c) An executed Release and Waiver of Liability for Testing of Children with Insulin-Dependent Diabetes form, a copy of which is attached hereto as Exhibit 3 (the "Release"). As set forth in the Release and without derogation of its contents, this form releases KinderCare from liability stemming from any action taken with reasonable care by KinderCare's employees and/or agents in conformance with the child's Authorization Form;
(d) Complete maintenance and proper disposal of all materials and equipment, including keeping the blood glucose meter in good working order (i.e., cleaning and performing controlled testing per the manufacturer's instructions); and
(e) The parties understand and agree that nothing in Paragraph 3 of the Release shall be construed to supersede or replace any provision of this Agreement.

10. KinderCare may require the parent(s) or guardian(s) to update the Authorization Form every six (6) months, or sooner if the child's needs change.

11. KinderCare shall admit (and not place on any waiting list) Jesi Stuthard to its child care program at the KinderCare Learning Center at 3860 Hoover Road in Grove City, Ohio, within three (3) days of the effective date of this Agreement or sooner upon execution of all enrollment forms and completion of all enrollment procedures applicable to all children enrolling in a KinderCare program, and shall maintain his enrollment in an age appropriate program consistent with KinderCare's practices and procedures with respect to all children. KinderCare will admit Jesi Stuthard to any other KinderCare facility in accordance with KinderCare enrollment procedures upon request of his parent or guardian and execution of all enrollment forms applicable to all children enrolling in a KinderCare program.

12. KinderCare shall provide disability sensitivity training to KinderCare personnel who have direct contact with children in its centers and/or direct contact with parent(s)/guardians(s) of children enrolled or seeking enrollment in a KinderCare program. This training obligation shall last for a period of not less than three (3) years and will cover, but is not limited to, the following ADA topics: enrollment of children with disabilities who otherwise qualify for admission to KinderCare, including eligibility criteria and the prohibition of surcharges; making reasonable modifications to its policies, practices, and procedures when necessary to integrate children or parent(s)/guardian(s) with disabilities when doing so does not fundamentally alter the nature of its goods and services and would not impose an undue burden upon KinderCare; integrating children with disabilities into its regular program to the maximum extent appropriate for the needs of the child; providing personal services to children with disabilities when personal services are provided to others; providing effective communication to children and parent(s)/guardian(s) with disabilities by furnishing appropriate auxiliary aids and services unless doing so would impose an undue burden or fundamentally alter the nature of KinderCare's goods and services; and removing architectural barriers where readily achievable.

13. In all centers in which children with insulin-dependent diabetes are enrolled or are about to be enrolled, KinderCare will cooperate with the parent(s) or guardian(s) of any such children so that the caregivers at KinderCare may be instructed as to the working of each child's particular blood glucose meter. In addition, KinderCare shall advise all KinderCare staff members at such centers, who in KinderCare's reasonable judgment have a need to know, which children have insulin-dependent diabetes, provide information about the symptoms and signs of hypoglycemia (low blood glucose), and provide training on the procedures to follow in the event of an emergency.

14. Within ten (10) days of the effective date of this Agreement, KinderCare will appoint a Disability Services Coordinator ("DSC") or equivalent to attempt to resolve disability-related issues raised by customers or potential customers as such issues arise. Responses to disability-related questions shall be provided within a reasonable time.

15. Within thirty (30) days of the effective date of this Agreement, and through December 31, 2001, KinderCare will prominently display an announcement at each KinderCare site throughout the country in an area readily visible to employees and existing and potential customers. This announcement will include, but is not limited to, the following:

"KinderCare does not discriminate on the basis of disability. KinderCare has appointed a Disability Services Coordinator to attempt to resolve disability-related issues.

[name]
[address]
[toll-free telephone number] (voice and TDD)".

This portion of the announcement will appear in no less than 18 point type in a san-serif font and will be printed in such a way that there is a high level of contrast between the background and print colors.

16. Within fourteen (14) days of the effective date of this Agreement, KinderCare will send notices to each of its child care centers within the United States informing them of the substance of this Agreement and requiring the modification of existing information handouts, enrollment materials, and registration forms to bring them into conformity with the policies adopted herein.

17. Within thirty (30) days of the effective date of this Agreement, KinderCare will distribute to each of its child care centers within the United States new information handouts, enrollment materials, and registration forms that state policies in conformity with this Agreement to the extent that existing handouts, materials and forms cannot be modified. Each of these will contain the full statement referenced in Paragraph 15, which will be printed in 10 point type or larger. KinderCare will instruct each center to destroy all unused copies of such printed matters that reflect company policies rendered invalid under this Agreement to the extent that such printed matters cannot be modified.

18. KinderCare has provided to the United States a copy of the ADA and KinderCare Manual. The United States has provided, with respect to said Manual, and will continue to provide informal technical assistance to KinderCare as it develops employee training materials to implement this Agreement, as authorized by 42 U.S.C. ß 12206(c)(1). Statements in KinderCare's employee training materials are not binding upon the Department of Justice.

19. KinderCare will instruct each Center Director to consult with the DSC before rejecting any application for enrollment on behalf of a child with a disability to the extent that the Center Director is aware that such child is an individual with a disability within the meaning of the ADA. KinderCare will maintain a record at its corporate headquarters of all such admission inquiries on behalf of children with disabilities, including insulin-dependent diabetes, and the disposition of such inquiries for a period of one (1) year from the date of inquiry.

20. KinderCare agrees to make the payments listed in a separate letter between counsel for the Plaintiffs and KinderCare the provisions of which are and shall remain confidential. The payments shall be made when this Agreement is fully executed by all parties.

21. The United States agrees not to sue KinderCare in conjunction with its investigations of DJ 202-58-18 and DJ 202-26S-3 and on all matters set forth in this Agreement, unless KinderCare violates this Agreement, in which case the United States agrees to provide KinderCare with an opportunity to cure in accordance with Paragraph 25 herein.

22. Patricia Dollison, as next friend of Jesi Stuthard, agrees that she may enforce this Agreement only to the extent that its provisions directly and individually affect Jesi Stuthard's enrollment, finger-prick testing, care and/or continued enrollment at KinderCare.

23. The United States may enforce all provisions of this Agreement. For three (3) years from the effective date of this Agreement, the United States may request KinderCare to provide the government with information or documentation regarding the implementation of any provision or provisions of this Agreement. If KinderCare receives such a request from the United States, it will use its best efforts to provide a complete, written response to the request within ten (10) business days.

24. KinderCare reports that it has approximately 1,200 centers, 22,000 employees, and 120,000 children enrolled nationwide and has a high employee turnover rate. The United States acknowledges that, in view of these factors, KinderCare's good faith efforts to satisfy the employee education provisions and implementation procedures set forth in this Agreement shall satisfy the good faith standard of 42 U.S.C. ß 12188(b)(5), notwithstanding that not all KinderCare employees may be fully knowledgeable about the totality of the company's disability-related policies at all times.

25. In the event that the United States believes that KinderCare is not fully complying with the terms of this Agreement, it will so notify KinderCare in writing and will provide KinderCare with an opportunity to cure, pursuant to Executive Order 12778, even if this Executive Order is amended or repealed. The United States and KinderCare shall engage in good faith negotiations to resolve any dispute arising under this Agreement. If, despite good faith negotiations, the United States and KinderCare are unable to resolve the dispute, the United States may institute a civil action in the United States District Court for the Southern District of Ohio to the extent that the dispute is directly with regard to Jesi Stuthard's enrollment, finger-prick testing, care or continued enrollment at KinderCare, and in all other cases in an appropriate Federal district court as authorized by 42 U.S.C. ß 12188(b)(2). The United States agrees that any such action to enforce the terms of this Agreement will be based solely upon KinderCare's actions after the effective date of this Agreement.

26. Failure by the United States to enforce this entire Agreement or any provision hereof with regard to any deadline or any other provision herein shall not be construed as a waiver of its right to do so with regard to other deadlines and provisions of this Agreement.

27. The American Diabetes Association and the American Diabetes Association, Ohio Affiliate, Inc., may enforce the provisions of this Agreement only to the extent that they pertain to children with insulin-dependent diabetes.

28. The parties to the Stuthard Case shall file a joint motion with the Court requesting that the Court dismiss the suit with prejudice provided, however, that in any subsequent lawsuit to enforce this Agreement, neither KinderCare nor Plaintiffs will oppose a request to the Court for expedited procedures to resolve the dispute.

29. This Agreement does not purport to remedy any other potential violations of the ADA not directly addressed in this Agreement. Nothing in this Agreement affects or relieves KinderCare of its responsibility to comply with any other Federal, State, or local law or regulation. Except as set forth herein, nothing in this Agreement is intended or shall be construed as a waiver by the United States of any right to institute any proceeding or action against KinderCare for any past, present, or future violations of any statutes, rules, or regulations administered by the United States.

30. Nothing in this Agreement is intended to cause KinderCare to violate the provisions of any state or local law; provided, however, that in the event KinderCare becomes aware of a state or local law or ordinance that prohibits KinderCare from monitoring the blood glucose levels of children with insulin-dependent diabetes enrolled in its program and so notifies the United States in writing, the United States will refrain from enforcing the Agreement with respect to the centers covered by the state or local law at issue for a period of sixty (60) days or until the United States and/or state and local officials resolve the matter. None of the parties to this Agreement is aware of any state, local and/or municipal laws in Ohio which prevent KinderCare from enrolling and caring for children as provided in this Agreement.

31. A copy of this Agreement shall be made available to any person upon request to the United States.

32. This Agreement is final and binding as to all signatories hereto, including all principals, agents, successors in interest and assigns of KinderCare and Plaintiffs. The undersigned representatives certify that they are authorized to enter into and consent to the terms and conditions of this Agreement and execute and legally bind their respective parties to it.

33. This Agreement shall constitute, and in executing this Agreement Plaintiffs and KinderCare hereto enter into, a full release as to any and all claims, including cross-claims or third-party claims, as to any and all events, actions, or matters that were or could have been raised in the Stuthard Case, as well as all other disputes or controversies arising from any and all transactions or relationships between KinderCare and Plaintiffs, occurring through the date of this Agreement, and except as to the rights and obligations created by the Agreement, KinderCare hereby fully and forever releases and discharges each of the Plaintiffs, their parent companies, subsidiaries, successors, predecessors, affiliates, agents, directors, trustees, officers, employees, members, attorneys and assigns, both past and present, from all claims, causes of action, losses, liabilities, and demands of any kind whatsoever, whether or not accrued, whether contingent or otherwise, whether liquidated or unliquidated, and whether known or unknown and the Plaintiffs hereby fully and forever release and discharge KinderCare, its parent company, subsidiaries, successors, predecessors, affiliates, agents, directors, trustees, officers, employees, members, attorneys and assigns, both past and present, from all claims, causes of action, losses, liabilities, and demands of any kind whatsoever, whether or not accrued, whether contingent or otherwise, whether liquidated or unliquidated, and whether known or unknown. Plaintiffs and KinderCare each are aware that they may hereafter discover claims or facts in addition to or different from those they now know or believe to be true with respect to the other parties to this Agreement. Nevertheless, as set forth above, it is the intention of the Plaintiffs and KinderCare to fully, finally and forever settle and release all matters and all claims related thereto, which do now exist or may heretofore have existed between KinderCare and the Plaintiffs. In furtherance of such intention, the releases given herein shall be and shall remain in effect as full and complete releases of all such matters notwithstanding the discovery or existence of any additional or different claims or facts related thereto.

34. This Agreement may be executed in duplicate counterparts.

35. This Agreement shall be effective from the date of the last execution in accordance with Paragraph 34 herein.

36. This Agreement sets forth and contains the entire agreement between and among Plaintiffs and KinderCare and the United States pertaining to the purpose and subject matter of this Agreement, and fully supersedes any and all prior oral and/or written agreements, understandings, communications or discussions of Plaintiffs, KinderCare and the United States or their counsel pertaining to the purpose and subject matter of this Agreement. No change in, modification of, or addition, amendment or supplement to this Agreement shall be valid unless set forth in writing and signed by or on behalf of Plaintiffs, KinderCare and the United States subsequent to the effective date of this Agreement.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date(s) set forth below.

FOR PLAINTIFFS:

Patricia Dollison, as Next Friend of Jesi Stuthard
The American Diabetes Association, and
The American Diabetes Association, Ohio Affiliate, Inc.

KINDERCARE LEARNING CENTERS, INC.

POLICY ON TESTING BLOOD GLUCOSE LEVELS

Children with insulin-dependent diabetes may require routine monitoring and regulating of their blood glucose levels. Parent(s)/guardian(s) of children with diabetes have several options for monitoring and regulating, each of which must be authorized by the parent(s)/guardian(s) in writing. Parent(s)/guardian(s) can choose to have any of the following people test the blood glucose levels of any such children:

1. The child can test himself or herself, if old enough and responsible enough and authorized by the parent(s)/guardian(s) on the Authorization for Care of Children with Insulin-Dependent Diabetes (the "Authorization Form");

2. The parent(s)/guardian(s) is welcome to come to KinderCare and do his or her own testing;

3. KinderCare staff will test blood glucose levels (including administering a "finger-prick" test) and take those steps to regulate the child's blood glucose as authorized by the parent(s)/guardian(s) on the Authorization Form; or

4. Parent(s)/guardian(s) can arrange for someone else to provide testing and treatment.

Parent(s)/guardian(s) must provide the following:
1. A signed copy of KinderCare's Authorization Form. This form must be filled out completely by the child's doctor and parent(s)/guardian(s), and must be updated every six (6) months or more often, if needed. The form is designed to provide KinderCare with information necessary for ensuring proper management of the child's diabetes and quick and effective response to emergencies.

2. All equipment and specialty foods needed for testing or treatment. The parent(s)/guardian(s) is responsible for the maintenance of materials and equipment, including ensuring that the blood glucose meter is in good working order. KinderCare is not responsible for damage or loss of equipment or specialty foods, so long as KinderCare has exercised reasonable care in storing and using these items.

3. A signed copy of KinderCare's "Release and Waiver of Liability for Testing of Children with Diabetes." This form releases KinderCare and its employees from liability for administering the blood glucose test and taking actions set out on the Authorization Form, provided KinderCare exercises reasonable care in following the doctor's and parent's(s')/guardian's(s') instructions.

If you have any questions, please contact KinderCare's Disability Services Coordinator at 1-800-____________________ or your Center Director.

KINDERCARE LEARNING CENTERS, INC.
RELEASE AND WAIVER OF LIABILITY FOR TESTING
OF CHILDREN WITH INSULIN-DEPENDENT DIABETES

THIS IS A RELEASE AND WAIVER OF LIABILITY FOR TESTING OF CHILDREN WITH INSULIN-DEPENDENT DIABETES (hereinafter referred to as "Release") made this _____ day of _____________, 19__, by and between KINDERCARE LEARNING CENTERS, INC. ("KinderCare") and ________________________ and __________________________ residing at __________________________________________, who are the parent(s) or guardian(s) of ___________________________________.

WHEREAS, KinderCare provides child care services at numerous facilities throughout the country and the Parent(s) or Guardian(s) has engaged KinderCare to provide child care services for ____________________________;

WHEREAS, KinderCare has been requested by the Parent(s) or Guardian(s) to provide blood glucose testing to the child during certain time periods when the child is enrolled in KinderCare and to take certain actions as a result of the blood glucose testing as prescribed in writing on the child's "Authorization for Care of Children with Insulin-Dependent Diabetes", all in accordance with, and subject to, the KinderCare Policy on Testing Blood Glucose Levels.

NOW, THEREFORE, in consideration of the agreements and covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto hereby agree as follows:

1. The Parent(s) or Guardian(s) hereby release and forever discharge KinderCare and its employees or agents from any and all liability arising in law or equity as a result of KinderCare's employees or agents performing with reasonable care blood glucose testing and/or taking actions in conformance with the child's "Authorization for Care of Children with Insulin-Dependent Diabetes". The Parent(s) or Guardian(s) also hereby release and forever discharge KinderCare from any loss or damage incurred in the exercise of reasonable care to any materials and/or equipment supplied by the Parent(s) or Guardian(s) in connection with the blood glucose testing.

2. This Release shall be governed by the laws of the State of _________________, which is the location of the KinderCare facility in which the child is enrolled, excluding its choice of law provisions.

3. This Release supersedes and replaces all prior negotiations and all agreements proposed or otherwise, whether written or oral, concerning all subject matters covered herein. This instrument, along with the form entitled "Authorization for Care of Children with Insulin-Dependent Diabetes," which is hereby incorporated by reference, constitutes the entire agreement among the parties with respect to the subject matters discussed herein.

4. The reference in this Release to the term KinderCare shall include its affiliates, successors, directors, officers, employees and representatives. The terms Parent(s)/Guardian(s) shall include the dependents, heirs, executors, administrators, assigns and successors or each.

5. If one or more of the provisions of this Release shall for any reason be held invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect or impair any other provision of this Release. This Release shall be construed as if such invalid, illegal or unenforceable provisions had not been contained herein.

Authorization for Care of Children
with Insulin-Dependent Diabetes

Date: _______________________________

Dear Doctor:

Your patient, __________________________, is enrolled/enrolling in our center and we have been requested to provide blood glucose monitoring. Please complete this instruction record. This record will remain in the child's file at KinderCare so we may assist with the diabetes care and needs of our enrollee and your patient.

ProceduresBlood glucose testing is performed before lunch and if the child exhibits those signs or symptoms of hypoglycemia which are on the attached Form. Parent(s) or Guardian(s) must supply blood glucose monitoring materials (meter and strips or chem strips). Other materials shall include (give detail) .

Dealing with low blood glucose less than_____________:1. Treat with one of the following fast-acting carbohydrates in the following quantities (please delete those which are not recommended): _______oz. apple or orange juice; _______ milk; _______ soda with sugar; #______ glucose tablets; OR other:______________________________
2. If lunch or snack is greater than one hour away, ALSO give one of the following complex carbohydrates in the following quantities: #______graham cracker squares; #______saltines; #______pieces of bread or toast; OR other:_____________________
3. Repeat blood glucose test in _______ minute intervals until levels come within target range.
[ ] Yes [ ] No
4. Repeat fast-acting carbohydrates if symptoms persist or resume within 15 minutes.
5. If child experiences a medical emergency, such as losing consciousness or having a seizure, call "911" or other emergency medical personnel, parent(s) or guardian(s), and child's doctor's office.
6. Attempt to notify parent(s)/guardians(s) for blood glucose out of above target range.
7. Other (explain):

Dealing with high blood glucose:1. Send notification home if blood glucose is more than 200.
2. Call parent(s) or guardian(s) and child's doctor if blood glucose is more than 400.
3. Other (explain):

Recreational Activities:1. The child may participate in recreational activities [ ] Yes [ ] No
2. Activity restrictions: [ ] None [ ] Some Restrictions Explain
3. Recreational activities should be delayed if blood glucose is higher than 300 or lower than 70.
4. Fast-acting carbohydrate should be readily available at all times, and should be administered immediately even if blood glucose meter is not available, should low blood glucose symptoms occur.

Why is it important to follow the ADA and allow children with diabetes to enroll in daycare programs?

-It's important for children with diabetes. Preventive health care is essential for the continued good health of children with diabetes. Kids with diabetes can lead active, healthy lives, but not without proper monitoring and care of their condition, and by doing finger-prick tests.

-It's important for parents. Parents of children with diabetes often have had a hard time finding child care where they will not have to choose between the simple steps necessary for their child's health and a needed job. Following the ADA gives parents a meaningful child care opportunity.

-It's important for teachers. If a child with diabetes starts to act up, it may be because of a low blood glucose level rather then intentional bad behavior. A child care provider can test and correct a low blood glucose level, thus eliminating a discipline problem.

How many people are affected by today's settlement?

There are about 100,000 children under the age of 18 with diabetes in the United States. Those children, their parents, friends and family are all positively affected when child care providers comply with the ADA. Additionally, there are about 16 million Americans with diabetes.

Will it be difficult or expensive for a child care provider to comply with the law?

No. Caring for children with diabetes is cost-free. It is the parent's responsibility to provide the child care center with a blood glucose monitor, paper strips and sterilized lancets. It takes only a few minutes to do a finger-prick test.

What are diabetes-related do's and don'ts for child care providers under the ADA?

- Do give children with diabetes daily finger-prick tests as necessary;

- Do pay attention to the doctor's and parents' dietary and health instructions for the child;

- Don't ask whether a child has diabetes before a child enrolls at a facility;

- Don't unlawfully prevent or otherwise discourage parents from seeking to enroll their child with diabetes in child care.